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This is the conclusion to 53 year old male: Severe leg pain. You may wish to review the case. Before we begin, my apologies for the delay in posting this conclusion. I live in coastal NY, and we got hammered by Hurricane Sandy. It has taken me a little time to get all caught up. […]

This great case was sent in by faithful reader Bryan Brzycki, a Medic from Beaufort County. As usual, some minor information may be changed to protect patient confidentiality. It's a cloudy fall morning when the tones go off and your unit is dispatched to the residence of a 53 year old male. When you and […]

This is part II to 59 year old male–"Lifting Boxes". You may wish to review the case. Let's review the ECG: There is sinus rhythm at about 90 bpm. Some of you saw a slight bit of ST elevation in the inferior leads, and maybe an abnormal aVL. Perhaps? Perhaps not? V1-V4 look possibly abnormal, […]

This great case was submitted by Vince DiGiulio, EMT-CC; we highly recommend you read his wonderful blog The Medial Approach to Emergency Medicine. As usual, the case has been altered to protect patient and provider privacy. You're working triage in a busy urban ED when an 88 year old female is brought in by her family. […]

This is part one of today's case study. As usual some information has been changed to protect patient confidentiality. EMS is called to the residence of a 59 year old male, who's chief complaint is chest discomfort. As the crew enters the kitchen, they find the patient sitting in a chair surrounded by family members. […]

This is the discussion for "Snapshot: 64 Year Old Male–Chest Pain". First, let's talk about the patient presentation.What is concerning is the substernal chest pain, radiating to the shoulder and neck area. While this occurred about 30 minutes after exercise, it did not occur during exercise, so that is somewhat atypical. Still, enough red flags […]

This is the discussion for "A change of Pace: What Happened?" My apologies for the delay! Pacemakers are amazing pieces of technology. They have evolved continually, and have given patients an increasing quality of life where none existed before. However, with this amazing technology comes a level of complexity that also has not been seen […]

Here is a challenging case this morning to stretch your mind… You are called to a 71 year old male feeling "sick". He has not felt well for the past 24 hours. He describes feelings of "general aches and pains". He has history of heart failure, for which he has an AICD. His vitals are […]

Here is the conclusion to 51 year old male: Chest Pain. You may wish to review the case. Here is the ECG again: There is a regular sinus rhythm at a rate of about 70. The QRS is narrow. The axis is normal, at about 15 degrees. Let's take a look at the constellation […]

Here is a great case submitted by faithful reader Niels, a Paramedic in Germany. As always, some minor information may have been changed to preserve patient confidentiality. Our case today takes us overseas, to the German countryside. It's a clear blue Monday morning, 11:40 am, when you and your partner are called to a 51 […]

Ken Grauer58 Year Old Male, Workout Worry@ Eli — I don’t see AFlutter. That is, I see no indication of regular atrial activity at a rate consistent with AFlutter. Instead, the rhythm is irregularly irregular without P waves = AFib at a controlled ventricular response. In my opinion, one doesn’t need Sgarbossa criteria here to activate the cath lab. So, yes the…
2018-09-13 02:09:24

Vince DiGiulioIs epinephrine harmful in cardiogenic shock?Sorry about that; I copied the quote from the article and my browser automatically changed the "μ" to an "m". Thanks for noticing, and thanks for pointing it out in the most passive-aggressive manner possible.
2018-09-12 16:45:26

Ken Grauer, MDElectrocardiographically Silent High Lateral STEMI EquivalentHi Tom. This is a great case — so NICE that you posted it for others to learned from. But as I commented several times when you sent this case around to our group — the T waves in V2,V3 are disproportionately peaked and transition occurs early (between V1-to-V2) — so the chest leads are NOT…
2018-08-14 08:38:03

Eli58 Year Old Male, Workout WorryAnybody else see the possibility of a LBBB or A-Flutter? I'm not sure if this will make any difference with the treatments but im just trying to interpret it first because if there is a LBBB then it does not meat Sgarbossa criteria and if it is A-Flutter that could explain the hyper acute T's…
2018-07-20 21:29:21